Friday, October 31, 2008

en·tro·py n. SymbolS For a closed thermodynamic system, a quantitative measure of the amount of thermal energy not available to do work.

My entire household has been wiped out with a nasty cold, and while I've continued telecommuting in the midst of it all I'm often finding myself staring vacantly at my laptop screen. My theory is that my energy is simply not available to do work. Thanks entropy!

On the information overload fun side of entropy here's The Counter-Entropy Squad, the Weill Cornell Medical Library's short film presentation on Wednesday, October 29th, 2008

I also found this rather bizarre entropy combat strategy thanks to my native homeland of Northern California (I'm betting Sonoma County.) I am apparently more of a cataloging geek than I knew because I immediately thought JS.. think that's something about government...E? There's JS but no JSE in LC...

Tuesday, October 28, 2008

As Publicity Chair (I think... this was in an email at some point many months ago when I was still in the haze of my first few weeks on the job) for the 2009 Pacific Northwest Chapter of the Medical Library Association (PNC/MLA) conference, I am thrilled to announce that special guest speakers Gene Ambaum and Bill Barnes of Unshelved are promoting our meeting in Seattle before we have a website up for it yet. Is that quality customer service or what?

Save the date for October 17-20, 2009, in Seattle at the Washington Athletic Club. I promise not to show up there in my workout gear or yoga pants and hopefully my colleagues will do the same.

The Maternal and Child Health Library released a new edition of theknowledge path, Domestic Violence. This electronic resource guidehas been released in time for Domestic Violence Awareness Month inOctober. The knowledge path points to recent resources aboutidentifying and responding to domestic violence within the home andthe community. Separate sections identify resources for families andresources about children exposed to domestic violence; datingviolence among adolescents; and violence between gay, lesbian,bisexual, and transgender partners. The knowledge path is availableat http://mchlibrary.info/KnowledgePaths/kp_domviolence.html.Knowledge paths on other maternal and child health (MCH) topics areavailable at http://www.mchlibrary.info/KnowledgePaths/index.html.

We welcome your comments and help in disseminating this informationto the health education and health promotion communities.

Speaking of queasy, I'm not sure how the ginger was prepared in the 19th century for the medicine chest but a 21st century preparation of it in lollipops (Preggie Pops, which have now evolved to drops) helped me function well enough that I never had morning sickness at work. Laudanum is ethanol with opium (yum!), and the other medicine chest contents are

Goulard's extract [a solution of lead acetate and lead oxide], paregoric elixir [a camphorated tincture of opium], spirits of nitre, oppodeldoc [a mixture of soap in alcohol, to which camphor and sometimes a number of herbal essences, most notably wormwood, were added] and ether.

VARY YOUR ANTISEPTICS; otherwise the disease germs will get used to them. The distinguished French physician and bacteriologist, Charles Richet, has recently laid before the French Academy of Sciences a note on researches made by him, together with Henry Cardot, on acquired characteristics and heredity in microbes. He experimented, among other things, on the influence of antiseptics, to determine especially whether bacteria may acquire immunity to toxic substances in the same manner that the higher animals do.

It's 2008, and methicillin-resistant Staphylococcus aureus (MRSA, or mer-sah... one of a handful of acronyms where you don't say each individual letter out loud) is a real threat due to exactly what Dr. Richet was warning the medical community about regarding antibiotic resistance almost a century ago.

Wednesday, October 22, 2008

The following is taken from a recent comment thread on my April 2008 post, "Clinical Plagiarism": Calling EMR copy/paste what it is that Reed Gelzer, MD, MPH, CDCC was kind enough to contribute to. I have only edited to explain acronyms & link directly to cited resources. Thank you very much, Dr. Gelzer, for these resources and informative insights that are not often part of the EMR decision, implementation and maintenance discussion. ~N.S. Dettmar

Here is a link to the public section of the American Health Information Management Association (AHIMA) website:

The electronic medical record (EMR) industry has been remarkably resilient to taking up basic documentation integrity functions, in large part because that is not something demanded by the buyers and users of these systems.

Eventually the accumulated weight of problematic and untrustworthy documentation will spill over into legal cases. Hopefully then the buyers and users of these systems will require better designed systems.

In the meantime, my associate and I have published a screening tool for evaluating electronic health records (EHRs) that we gave to AHIMA to publish as an article.

We find that many practices with EHRs do not know the risks these systems pose to them and so created these testing tools for an objective, reproducible evaluation of systems in place, or systems under consideration for purchase.

Copy functions in EHRs are actually just a subset of the problem of authorship accuracy. Since payment for services is driven by who actually provided the service, there are substantial financial incentives to use EHR capabilities to misrepresent who did what. Patricia A. Trites, of Healthcare Compliance Resources, often notes that EMR advertising especially highlights higher reimbursement as the main attraction of an EMR. Another auditing professional, Rebecca Busch of Medical Business Associates, notes that EMRs are simply too tempting to those she terms, "the ethically challenged".

My concern is that the majority of doctors, nurses, physician assistants (PAs) and other hardworking professionals will be doing things exactly as they should, but their EMR will betray them if ever challenged in a legal setting. For example, EMRs can dutifully record that documentation has been altered but not retain the original version, making it impossible for a doctor to prove that the alteration was not done for improper reasons.

I hope you have success in conveying to others the need for thorough due diligence in evaluating how a system actually works, to make sure it meets the basic requirements for valid, accurate, and trustworthy medical and business records.

On October 15th, the National Network of Libraries of Medicine, Southeast Atlantic Region (NN/LM SEA) shared what a joint task force of the Medical Library Association (MLA) and the National Library of Medicine (NLM) proposed for the definition of an PHR.

Let's compare the two:

NAHIT

Personal Health Record (PHR): An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

MLA-NLM Task Force

Electronic Personal Health Record (PHR): PHR is a private, secure application through which an individual may access, manage and share his/her health information. The PHR can include information that is entered by the consumer and/or data from other sources such as pharmacies, labs, and care providers. The PHR might or might not include information from the electronic health record (EHR) which is maintained by the health care provider and is not synonymous with the HER. PHR sponsors include vendors who may or may not charge a fee, health care organizations such as hospitals and health insurance companies, or employers.

Both are written as found with no editing or emphasis from me. I'm assuming HER in the latter quote is a typo, and one I may understand the origin of since I recently attended a forum (will blog about it soon!) where Word kept auto-correcting EHR to HER and it nearly drove me insane.

When it comes to explaining what a PHR is to the general public and not other people in the medical field, librarianship or information technology, I'm not sure either definition will be sufficient as a stand alone. I see a stronger possibility of "...what?" being their response to the one from the medical librarians with 4 sentences and 3 variables vs. NAHIT's single sentence with no variables.

I studied Pogue's Anti-Jargon Dictionary and think NAHIT's 'interoperability' may fall in alignment with his 'Functionality' complaint. Clarifying the 'multiple sources' as being healthcare-related would help so it's not totally arbitrary. The Social Security Administration will not suddenly suddenly plunk your disability information in your PHR... at least I hope not.

On the other hand, we in medical librarianship are fond of calling people 'consumers'... so why did the definition include both 'individuals' and 'consumers' for describing the same population? Was it really necessary to include all the 'and/or', 'might or might not', 'may or may not' variables up front for a basic definition? Why are we mentioning an electronic health record (EHR) in the definition for a PHR without also defining an EHR beyond something 'maintained by the health care provider', thus putting prior assumption on the consumer/individual to know exactly what that entails?

I am all for promotion of consumer health resources as part of PHR applications, but what exactly is the 'information assistance statement' that is being sent to these organizations to include in PHRs?

Am I a traitor to my field in respectfully disagreeing with the members of the joint task force about their definition for PHRs and wanting to use NAHIT's?

Friday, October 17, 2008

We've come a long way, baby. I make sure I watch this librarian vocational film once in a while to remind myself that this was cutting edge technology and information about the field at the time it was produced.

What will librarians (or whatever the job title turns into) of 2069 refer to in their era about ours? My great-grandfather's cousin is 103 and still sharp as a tack and my grandmother's cousin in her 80s runs our family's genealogy website, so perhaps I'll be a ninety-somethingbrarian and get to offer my own perspective on whatever media we're using then!

(above is an embedded video which may not show up in RSS feeds, it's from the Internet Archive and not YouTube)

About 8 minutes and 10 seconds into the film is a perky medical librarian. I share an alarming similarity with her in that my medical terminology pronunciation is currently pretty awful although I'm slowly making progress.

I particularly like this quote that is 9 minutes and 25 seconds into the film.

You will derive satisfaction from a knowledge that your work is vital and essential in forming the kind of world in which you want to live.

Wednesday, October 15, 2008

I've been writing Eagle Dawg Blog for a little over seven months and have always had a bit of an existential identity crisis in the middle of it. At first this was because I had no idea if I'd continue writing here since this was just a continuing education (CE) course assignment to fill in time before my pending job offer was finalized. However, I found that I not only continued writing after the CE was done, but that others were actually interested in what I had to say. This still really surprises me most days and I thank you for your time. I genuinely value it and hope to always offer you something useful except on Friday Fooleries, where there are no guarantees.

Who are you?

I'm fairly certain that if you're currently reading this you know exactly who I am in real life. There aren't many of us with brand new distance learning degrees from Texas running around in the Washington medical library community, but before now I have never officially connected the two identities. So, hi. My professional name is Nicole S. Dettmar and I work for the National Network of Libraries of Medicine (NN/LM) which is coordinated by the National Library of Medicine (NLM). If you call me Nicole you've either known me prior to summer 1990, are a telemarketer or someone calling about Official Business, or have made a cognitive disconnect due to repeated Facebook exposure where I waltz around with my legal name. In real life, both professional and personal, the post-1990 crowd calls me Nikki. I've updated my Blogger profile to reflect me as me. It trips me out when people call me Eagle Dawg, but I do respond to that too now.

What's the big deal about going by your name?

The big deal is, to my knowledge (please correct me if I'm wrong so I don't feel like such a freak) I am the only one in NN/LM & NLM currently writing a personal public blog about my perspectives in health informatics, medical librarianship, NLM resources, etc. In my real life fledgling medical library career I am often referred to by my employer more than who I am as an individual. That is fine within the context of my job, but I want to make a few things crystal clear here about me and Eagle Dawg Blog:

If you're an American taxpayer, you've already paid for these resources so it's not like I'm trying to sell you something.

Criticism of NLM/NIH/HHS is probably unavoidable. Don't you have days where you go bonkers from the bureaucracy?

Why are you going by your name now?

The truth? I don't know what direction scholarly publication will take in the future. I don't think it will include blogs in their current form, but what will these evolve into? I want all my work in this field to be known by and attributed to me as me and not me as a pseudonym. Yes, the recent Annoyed Librarian hiring at Library Journal spurred on this change to a certain extent, but so did receiving a recommended resource list with blogger pseudonyms instead of real names a few weeks ago.

What the heck is an Eagle Dawg anyway?

I was trying to think of what sounded creative and not cutesy with Blog for a name. Dawg quickly became obvious, the Husky is the mascot for the University of Washington & we are DAWGS not dogs. UW is where I (finally) received my Bachelor of Arts degree in Social Sciences and Communication in 2005 thanks to the evening degree program. I have also worked for UW for over 10 years, hopping from one department & career to another while getting married, having a chronic illness (now in remission), having a child and earning two degrees. Not many employers allow that much flexibility and I am most grateful for it. I wouldn't be where I am now without the unbelievable support of my former bosses and many coworkers.

If I was going to use Dawg as part of the blog name, then I also had to include the Eagle. That is the mascot of the University of North Texas, where I received my Master of Science in Information Science degree in 2007. The Eagle not only sounds better first, but needs to be thanks to an overwhelmingly generous fellowship UNT awarded me in distance learning health informatics. I have much to give back because I was given so much.

Friday, October 10, 2008

On Wednesday we had a phone call just before 5am. I know for a fact nothing good ever comes from phone calls that early in the morning to our house, and sure enough a family member (who is fine) needed a ride home from the emergency room.

On Wednesday, 2008 Nobel Prize in Chemistry winner Martin Chalfie received a phone call early in the morning too. He slept through it. When he awoke, he learned from the Internet that he was 1 of the 3 winners because he didn't answer the phone or think to check his voice mail that early.

(AP Photo/Harvard University, Livett- Weissman-Sanes-Lichtman)

During the 1960s Osamu Shimomura first identified the protein (GFP simply means green fluorescent protein) responsible for making a type of jellyfish that lives off the coast here glow in the dark. Chalfie demonstrated its value as a genetic marker in the 1990s after his graduate student Ghia Euskirchen was able to splice GFP into E. coli to create recombinant DNA, then he used it to mark certain neurons in C. elegans. Roger Tsien experimented with the amino acids (there are 20 in all proteins) in GFP to create a huge range of colors beyond green that can mark individual cells to study as shown in the picture above. (Source from nobelprize.org)

All this from a simple question: What makes those jellyfish glow?

What simple question do you have that might change the world?

Why is this here beyond the cool factor about anything that glows in the dark & the fact that you should always sleep lightly enough to hear the phone ring?

Genetics and biochemistry are dear to me because I was fortunate to be one of Mr. Stephen DeGusta's advanced biology high school students in the early 1990s. As a result of his connections in the field of genetic research our class was able to splice DNA several times, run them through agarose gel electrophoresis (I still have my final lab report with a picture of my gel), and do basic genetic engineering where we ligated a sequence for penicillin resistance into E. coli to create recombinant DNA then grew the cells on gels full of penicillin.

I've seen a few other shoutouts to Mr. DeGusta online, but it was about time for me to do my own. Some of my best hours in high school were spent cutting other classes and hiding in the lab behind his classroom (he knew full well I and plenty of others were back there) reading Scientific American and experimenting with planarians. Don't ask. You don't want to know.

Tuesday, October 7, 2008

I hadn't yet read all of the 13 articles in Decoding Your Health, a September 30th insert that was in the New York Times, and had bookmarked only one (You're Sick. Now What?) because I liked the title.

And 75 percent of online patients with a chronic problem told the researchers "their last health search affected a decision about how to treat an illness or condition," according to a Pew Report released last month, "The Engaged E-Patient Population."

I understand the pressure in journalism to get articles out fast. Honestly, I do. It's precisely because I feel Pew is misleading everyone from students to researchers (and now journalists) who are taught to trust them as a data source by mixing these 'memos' in with their regular reports that I'm far more frustrated with them than the New York/Seattle Times.

Would it be too much to ask to get your miscellaneous side projects into their own clearly defined section of your website and leave your excellent report data alone to avoid a repeat of this, Pew Internet?

Friday, October 3, 2008

USA Today has come out with a new survey - apparently, three out of every four people make up 75% of the population. ~David Letterman

I understand the need for statistics, truly I do. They speak succinctly to certain situations where descriptive statements don't, but can be misconstrued in so many different ways that I've become rather skeptical of them. I've been buried with good, bad, and downright sobering stats lately (all my state's neighbors rank among the top ten suicide rates in the nation along with an overwhelming number of other Western rural states) for work and needed a diversion.